There’s a strong case to be made for constitutional monarchies. But there’s no case for one in Australia


AAP/AP/Frank Augstein

Dennis Altman, La Trobe UniversityThe basic defence of constitutional monarchies came from the British writer Walter Bagehot 150 ago. He argued for a separation between the ceremonial and the actual holders of power. It is summed up in the expression “the Queen reigns but does not rule”.

Where the roles of head of state and head of government are combined, as in the United States, there are fewer restraints on the pretensions of political leaders.

Many of the countries we think of as most progressive are constitutional monarchies – the Scandinavian and Benelux countries, for example – and have hereditary monarchs. In Spain, the role of King Juan Carlos was crucial in the post-Franco transition to democracy, although he is now living in exile, accused of major corruption. In Japan, the decision of the Allies to retain the emperor was important in creating a liberal democratic system after the second world war, and the emperor continues to play an important ceremonial role.




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The Oprah interview is a royal PR nightmare, but republicans shouldn’t get their hopes up just yet


The old dominions of the British Empire – Canada, New Zealand, Australia –basically accepted the British sovereign as head of state, with a governor-general acting as effective head of state. This is a very peculiar constitutional arrangement. Australian passports are issued by the governor-general as “the representative of Her Majesty”, but on arrival at Heathrow airport we queue in the same line as other foreign nationals. Some small Pacific and Caribbean countries, including Papua New Guinea, have preserved the same system, and in several cases have rejected proposals for change.

Of course, the same balance between ceremonial and real power can be achieved through an elected head of state, as in Ireland, or one appointed through the legislature, as in Germany. Defenders of constitutional monarchy claim the hereditary principle removes the political element and provides a sense of historical continuity that promotes greater faith in the political system.

Constitutional monarchies are supported by a combination of nostalgia, national pride and deep distrust of politicians. In both European and Asian monarchies, the royal family stands as a symbol of national pride and a prop of existing social hierarchies.

For the British, the monarchy symbolises a sense of greatness that has long passed, but allows for largely harmless nostalgia. Thinking of Australia as part of the imperial family might have made sense when the predominantly Anglo colonies federated in 1901. It is patently absurd today.

Since John Kerr’s dismissal of Whitlam in 1975, it is difficult to imagine a governor-general, whether with or without the support of Buckingham Palace, doing anything similar. The larger problem is the prime minister is nominally accountable to a governor-general whom he or she has appointed.

The British prime minister has no such power, although the constitutional conventions would require the monarch to stand down should parliament so decree. The simplest solution to the Australian conundrum, as Donald Horne posited some decades ago, is to retain our current system but elect the governor-general.

Since the dismissal of Gough Whitlam in 1975, it is difficult to imagine another governor-general behaving in the same way as Sir John Kerr.
National Museum of Australia

At this point in our history, the resistance to constitutional change acts to perpetuate the status quo. Most politicians fear direct election would create a powerful challenge to parliamentary authority. Many populists are unwilling to trust politicians to choose a head of state.

This is not a feeling confined to Australia. A few years ago, one left-wing Dutch commentator lamented:

There has been a political crisis in the Netherlands for years, as most Dutch people have lost confidence in the main political parties. In the 21st century, more Dutch people trust the monarchy than the main political parties.

If anything, I suspect this distrust is greater today than it was when the Australian electorate rejected the republic in the 1999 referendum. That referendum came two years after the death of Princess Diana, which was a greater blow to the British monarchy than the recent Oprah interview with Harry and Meghan. Diana, after all, had been a future queen and the mother of a future king.




Read more:
After Oprah: what will it take to revive an Australian republic?


There are more pressing problems with our Constitution, above all the need to recognise the dispossession of the original inhabitants of what we now call Australia. But no-one writing an Australian constitution today would argue for a head of state living on the other side of the world who is effectively represented by a governor general, hand-picked by the head of government.

Had our monarchists been more far-sighted in 1901 they might have invited one of Queen Victoria’s surplus children to establish an Australian dynasty. At least we would then have our own constitutional monarchy to argue over.


Dennis Altman’s new book is God Save The Queen: The strange Persistence of Monarchies.The Conversation

Dennis Altman, Professorial Fellow in Human Security, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Top economists say cutting immigration is no way to boost wages


Wes Mountain/The Conversation, CC BY-ND

Peter Martin, Crawford School of Public Policy, Australian National UniversityAustralia’s top economists have overwhelmingly rejected cuts to either permanent or temporary migration as a means of restoring lost wage growth.

The 56 leading economists polled by the Economic Society and The Conversation include a former head of the Fair Pay Commission and a former expert member of the Fair Work Commission’s minimum wage panel.

Among the experts, selected by their peers, are specialists in economic modelling and the economics of labour markets from both the private and public sectors.

All but five rejected cuts in temporary migration as a means of boosting wage growth. All but three rejected cuts in permanent migration.

The results put the economists at odds with Reserve Bank Governor Philip Lowe, who last month drew a link between temporary migration and weak wage growth saying employers had been using overseas hires to fill gaps that would have been filled by locals, diluting “upward pressure on wages in these hotspots”. He said this might have spilled over to rest of the labour market.

Cutting temporary and cutting permanent migration were the first two of ten options for boosting wage growth presented to the panel of economists. The panel rated them third last and second last. Only “holding back growth in female and older worker participation” was marked down more.

Each economist was asked to pick three of the ten options. The most popular, picked by 78.2%, was measures to boost productivity growth. The next most popular, picked by 50.9%, was measures to boost business investment.



Michael Keane of The University of NSW said the idea that population growth and increased labour supply were constraining wage growth was “so naive as to not really be worthy of comment”.

Consultant Rana Roy said only a “cultivated amnesia” could ignore the near-uninterrupted growth in real wages in US, industrialised Europe and Australia amid record inbound immigration in the decades after the second world war.

Gabriela D’Souza of the Committee for Economic Development of Australia said the idea owed much to a “one dimensional view of the world” that took account of only the direct impact of immigrants on particular wages and not the impact of their demand for goods and services on a broader range of wages.

Dozens of studies had identified the overall impact as “near zero”.

Productivity ‘almost everything’

Robert Breunig of the Australian National University said immigrants appeared to add to productivity rather than detract from it, meaning slowing down immigration could slow down rather than add to productivity and growth.

Three quarters of the panel nominated productivity growth as the most important precondition for higher wages growth, endorsing the conclusion of Nobel Prize winning economist Paul Krugman that “productivity isn’t everything, but in the long run it is almost everything.”

Krugman famously added that a country’s ability to improve its standard of living
over time depended “almost entirely on its ability to raise its output
per worker”.


Wages growth is way below the Reserve Bank’s +3% target

Total hourly rates of pay excluding bonuses, seasonally adjusted. Change from corresponding quarter of previous year.
ABS Wage Price Index

Ian Harper, a former head of the Howard government’s Fair Pay Commission and a current member of the Reserve Bank board, said that without productivity growth, any boost in wages growth that was delivered was likely to be nominal — matched by inflation — rather than real, delivering higher living standards.

One of the best tools for lifting production per worker was business investment.

One of the five economists who thought immigration hurt wages growth, Macquarie University’s Geoffrey Kingston, said it seemed to do it by thinning investment per worker. In the 1980s, under Prime Minister Bob Hawke, increased immigration helped push down real wages for five years in a row.

Several of those surveyed said wage growth needed investment in more than machines. Griffith University’s Fabrizio Carmignani said what also mattered was investment in “human capital” via education and research and development.




Read more:
Exclusive. Top economists back unemployment rate beginning with ‘4’


Adrian Blundell-Wignall, a former division chief at the Organisation for Economic Co-operation and Development, said reforming the education system and getting rid of elitism had to be part of the plan.

“That the best predictor of how well you do at school is how rich your parents are and where they went to school is a national tragedy,” he said. “The entitlement and club economy that comes with this permeates politics, business, and who gets the best jobs after completing school.”

Former Rudd and Gillard government minister Craig Emerson said while measures to boost productivity growth were essential, even if implemented soon, they would take years to flow through into higher wages.

It’s how you divide the pie

Saul Eslake said whether or not higher productivity growth actually delivered higher real wages would depend on the division of the fruits of that growth between wages and profits.

John Quiggin said nearly every reform of Australia’s industrial relations system since 1975 had acted to reduce the bargaining power of unions. All ought to be reviewed with a “presumption in favour of repeal”.

Mala Raghavan of the University of Tasmania said wage growth had become uneven. Wages for a small number of managers had soared while wages for others — especially casual workers — had barely moved.




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The Australian National University’s Emily Lancsar saw a triple benefit from reforming the industrial relations system to boost union bargaining power: it would increase wages directly, it would put money that would have been paid out as profits in the hands of people likely to spend it, and the increases would flow through to workers not on awards and not represented by unions.

Labour market specialist Jeff Borland added that there was a case for strengthening the ability of unions to obtain gender pay equity in female-dominated occupations.

None of those surveyed were optimistic about the prospect of quickly lifting wages growth. The Reserve Bank said in July it wasn’t planning to lift interest rates until aggregate growth exceeded 3%.


Detailed responses:

The Conversation

Peter Martin, Visiting Fellow, Crawford School of Public Policy, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Now that Australia’s inflation rate is 3.8%, is it time to worry?


ABS/Shutterstock

John Hawkins, University of CanberraSuddenly, Australia’s annual inflation rate is 3.8%, having jumped from 1.1% for the twelve months to March.

The June quarter jump follows a jump in the United States to 5.4% and a jump in New Zealand to 3.3%, sparking a debate between leading pundits such as former US treasury secretary Larry Summers and Nobel Prize winner Paul Krugman about whether high inflation is on the way back, after years of playing dead.


Annual inflation, Australia


Australian Bureau of Statistics

The best advice is not to worry. Most of the jump is only temporary, the result of several one-offs.

As the Reserve Bank told us back in May, a main cause is that in the depths of COVID lockdowns last year, the government heavily subsidised child care, pushing the effective price to near zero.

With removal of those subsidies the price has bounced back. This is a one-off — it can’t be repeated.

Reasons to not worry

Petrol prices also collapsed as cities locked down last year, and have since returned to pre-COVID levels. This is another one-off that won’t be repeated.

There were also big jumps in the prices of some fruit and some vegetables due to a shortage of pickers and heavy rainfall. They are also best seen as one-offs.

The “trimmed mean” measure of so-called underlying inflation used by the Reserve Bank to see through transient influences was only 1.6%. It’s a better guide to what is going on.

Reserve Bank Governor Lowe.

This also true in other countries. The Bank for International Settlements concluded this month that a common thread in recent increases in inflation was that they were “likely to be temporary”.

The Reserve Bank is expecting inflation back below 2% by the end of the year. The bank forecasts consumer prices to rise by 1.5% through 2022.

Most economists broadly agree. The average forecast from The Conversation’s panel was an inflation rate of 2.1% in 2022.

What about the traders in financial markets, whose pay depends on trying to guess inflation right?

The traders’ average forecast can be derived from what they will pay for inflation-indexed compared to non-indexed bonds.

Over the next ten years, they expect inflation to average 2%.

But isn’t too much money being printed?

Yes, there have indeed been such claims, often by people trying to talk up the value of cryptocurrencies through internet memes.

It is true that as the Reserve Bank sought to steady the economy last year, there was a period of rapid monetary growth. In times of uncertainty, people tend to want to hoard some money.

But the same thing happened during the global financial crisis in 2008. It didn’t end up leading to high inflation then. It is unlikely to do so now.

Concerns have also been expressed that central banks have been buying too many government bonds — so-called “quantitative easing”. These fears were expressed internationally during the global financial crisis. They proved unfounded.

What else might push up inflation?

There are some longer-run structural changes. After the global financial crisis, the effective supply of workers in the global economy grew due to demographic factors and the re-engagement of China.

Some of the demographic factors may be reversing, but the effect will be gradual.

It is also true that many economies, including Australia’s, rebounded from last year’s COVID lockdowns faster than expected. This has led some commentators to talk about overheating.




Read more:
What’s in the CPI and what does it actually measure?


But now the emergence of the more contagious Delta strain has seen a new round of lockdowns. The Australian economy is likely to contract in the September quarter, making our recovery look W-shaped rather than V-shaped as it did.


The Conversation, June 2 2021

A big rise in inflation is unlikely unless wages grow strongly. There is no sign of this. Australia’s wage price index is climbing by just 1.5%.

But what if the experts are wrong?

Contrary to some claims, the Reserve Bank has not promised to keep interest rates on hold at 0.1% until 2024.

As the bank’s governor has made clear, if inflation accelerates into its target band it will raise interest rates earlier.

Since the Reserve Bank introduced its 2-3% target, inflation has averaged 2.4%. There is no reason to think it won’t continue to act to keep it moderate.

But if I still fear inflation, what should I do?

You should look for a good “inflation hedge”, an asset that will increase in price with inflation.

It is possible to buy indexed government bonds.

Rents and dividends also tend to rise with inflation, meaning houses and shares have proved reasonable inflation hedges in the past.

Assets with no returns, such as gold and cryptocurrencies, are less reliable. The price of Bitcoin has more than halved in two of the past seven years, so beware.The Conversation

John Hawkins, Senior Lecturer, Canberra School of Politics, Economics and Society and NATSEM, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

If I’ve already had COVID, do I need a vaccine? And how does the immune system respond? An expert explains


Andre Coelho/EPA/AAP

Sunit K. Singh, Banaras Hindu UniversityOver a year into the pandemic, questions around immune responses after COVID continue to confound.

One question many people are asking is whether the immunity you get from contracting COVID and recovering is enough to protect you in the future.

The answer is no, it’s not.

Here’s why.

Remind me, how does our immune response work?

Immune responses are innate or acquired. Innate, or short-term immunity, occurs when immune cells that are the body’s first line of defence are activated against a pathogen like a virus or bacteria.

If the pathogen is able to cross the first line of defence, T-cells and B-cells are triggered into action. B-cells fight through secreted proteins called antibodies, specific to each pathogen. T-cells can be categorised into helper T-cells and killer T-cells. Helper T-cells “help” B-cells in making antibodies. Killer T-cells directly kill infected cells.

Once the battle is over, B-cells and T-cells develop “memory” and can recognise the invading pathogen next time. This is known as acquired or adaptive immunity, which triggers long-term protection.

What happens when you get reinfected? Memory B-cells don’t just produce identical antibodies, they also produce antibody variants. These diverse set of antibodies form an elaborate security ring to fight SARS-CoV-2 variants.

Natural immunity is not enough

Getting COVID and recovering (known as “natural infection”) doesn’t appear to generate protection as robust as that generated after vaccination.

And the immune response generated post-infection and vaccination, known as hybrid immunity, is more potent than either natural infection or vaccination alone.

People who have had COVID and recovered and then been vaccinated against COVID have more diverse and high-quality memory B-cell responses than people who’ve just been vaccinated.

Studies indicate mRNA vaccines generate a more potent immune response with previous infection, at least against some variants including Alpha and Beta.

And studies have shown that antibody levels were higher among those who’d recovered from COVID and were subsequently vaccinated than those who’d only had the infection.

Memory B-cells against the coronavirus have been reported to be five to ten times higher in people vaccinated post-infection than natural infection or vaccination alone.

Is one dose enough after COVID?

Some reports have suggested people who’ve had COVID need only one dose of the vaccine. Clinical trials of approved vaccines didn’t generate relevant data because people who’d already had COVID were excluded from phase 3 trials.

One study from June showed people with previous exposure to SARS-CoV-2 tended to mount powerful immune responses to a single mRNA shot. They didn’t gain much benefit from a second jab.

A single dose of an mRNA vaccine after infection achieves similar levels of antibodies against the spike protein’s receptor binding domain (which allows the virus to attach to our cells) compared to double doses of vaccination in people never exposed to SARS-CoV-2.

We need more studies to fully understand how long memory B-cell and T-cell responses will last in both groups.

Also, a single dose strategy has only been studied for mRNA-based vaccines. More data is required to understand whether one jab post-infection would be effective for all the vaccines.

At this stage, it’s still good to have both doses of a COVID vaccine after recovering from COVID.

Does Delta change things?

The development of new vaccines must keep pace with the evolution of the coronavirus.

At least one variant seems to have evolved enough to overtake others, Delta, which is about 60% more transmissible than the Alpha variant. Delta is moderately resistant to vaccines, meaning it can reduce how well the vaccines work, particularly in people who’ve only had one dose.

There’s no data available yet about how effective a single jab is for people who were previously infected with Delta and recovered.




Read more:
Why is Delta such a worry? It’s more infectious, probably causes more severe disease, and challenges our vaccines


The most important thing you can do to protect yourself from Delta is to get fully vaccinated.

According to a Public Health England report, one dose of Pfizer offered only about 33% protection against symptomatic disease with Delta, but two doses was 88% effective. Two doses was also 96% effective against hospitalisation from Delta. The AstraZeneca vaccine was 92% effective against hospitalisation from Delta after two doses.

A few vaccine manufacturers, including Pfizer, are now planning to use a potential third dose as a booster to combat the Delta variant.The Conversation

Sunit K. Singh, Professor of Molecular Immunology and Virology, Institute of Medical Sciences, Banaras Hindu University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Should we vaccinate children against COVID-19? We asked 5 experts


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Phoebe Roth, The ConversationAustralia’s Therapeutic Goods Administration (TGA) recently announced provisional approval for the Pfizer vaccine to be used in 12-15-year-olds.

We learned on Monday that the Australian Technical Advisory Group on Immunisation (ATAGI) has advised that Aboriginal and Torres Strait Islander children aged 12-15, those who live in remote communities, and those with underlying medical conditions should be prioritised to receive the jab.

With COVID vaccination for kids being such a hot topic, we asked five experts whether we should vaccinate children in Australia against COVID-19.

Four out of five experts said yes

Here are their detailed responses:


If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: phoebe.roth@theconversation.edu.au.


Disclosures:

Asha Bowen is co-chair of the Australian and New Zealand Paediatric Infectious Diseases (ANZPID) group of the Australasian Society of Infectious Diseases. She receives research funding from NHMRC.

Catherine Bennett has received NHMRC and MRFF funding, and is an independent expert on the AstraZeneca advisory board.

Julian Savulescu receives funding from the Wellcome Trust. This work was supported by the UKRI/AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1.

Margie Danchin is a member of ATAGI’s working group on vaccine safety, evaluation, monitoring and confidence.

Nicholas Wood holds an NHMRC Career Development Fellowship and Churchill Fellowship.The Conversation

Phoebe Roth, Deputy Editor, Health+Medicine, The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Vaccine selfies may seem trivial, but they show people doing their civic duty — and probably encourage others too


 

Shutterstock

Louise Grimmer, University of Tasmania; Gary Mortimer, Queensland University of Technology, and Martin Grimmer, University of Tasmania

Have you been vaccinated yet? And if you have, are you one of a growing number of people who posted a selfie on social media afterwards? At a time when many people distrust government advertising, vaccine selfies — or “vaxxies” — may well be the secret weapon to encourage more people to get the jab.

Suddenly our Facebook, Twitter and Instagram feeds are filling up with selfies of family, friends and even strangers getting their COVID shot.

But vaxxies are more than mere selfies, as they have a unique social function. They are likely helping normalise the vaccine procedure, reducing hesitancy around perceived risks and increasing vaccine trust within social circles.

 

 

 

As governments and health officials continue to flip-flop on vaccine age requirements, and anti-vaxxers spread falsehoods through social media and protests, the vaxxie might just be a powerful line of defence against vaccine hesitancy.


Read more: Public protest or selfish ratbaggery? Why free speech doesn’t give you the right to endanger other people’s health


As of July 21, more than 10.6 million COVID vaccine doses had been administered in Australia. As time passes, more and more people are showing their support by posting about their vaccination experience online.

Normally, we see this type of behaviour demonstrating “civic duty” during elections or with social movements such as Pride or Black Lives Matter. We’re now seeing similar posts involving vaccination, using a variety of hashtags including #vaxxie, #GetVaccinated, #GetVaccinatedNow, #Vaccination and #jab.

 

In friends we trust

The vaxxie could be a useful tool in encouraging people to get vaccinated. Over the past decade in particular, there has been an erosion of trust in traditional advertising and a huge surge in social media use.

This means word-of-mouth recommendations and reviews from people we know (and even people we don’t) are often considered more “authentic” than standard advertising and government messaging.


Read more: Australia’s new vaccination campaign is another wasted opportunity


Research indicates we look to our friends, family and social groups for guidance during uncertain times. They provide us with subjective norms: the desire to behave as those who are significant to us think we should.

This results in social pressure to engage in certain behaviours. If our family and friends are posting vaxxies, it’s an implicit nudge for us to get vaccinated too. And as reported vaccine shortages continue and demand grows, seeing vaxxies can also increase our fear of missing out (FOMO).

 

In-groups and out-groups

In the same way one shows support for social movements on social media, sharing a vaxxie communicates your position on vaccinations — you are either pro-vax or anti-vax. Essentially, you are either with us or against us: a hallmark of classic in-group/out-group behaviour.

The psychology of the in-group/out-group is best illustrated using social identity theory. This theory states internal cohesion and loyalty to the in-group exists when the group members maintain a state of almost hostility or assertive opposition toward out-groups — which are often perceived as inferior.

This theory explains spectator behaviour at sporting events. As we see more of our friends sharing their vaxxies, we may desire to be a member of the “in-group”. But to be in this group, we need to get a jab (and show evidence with our own vaxxie).

The in-group pressure may be further increased when we see our political leaders or favourite celebrities get involved. US President Joe Biden, Dolly Parton and Sir Ian McKellen are just some of the icons whose vaccinations made headlines.

Dolly Parton posted her own vaxxie.

Risks of virtue signalling

One of the main risks in posting a vaxxie is it could alienate others through virtue signalling, which is when a person behaves in a way that highlights their own “good” moral values. People on Facebook will often loudly proclaim their support for a certain cause because they want to seem caring or “woke”.

But most of us aren’t impressed by those who overtly express their own moral correctness. There’s a fine line between encouraging others to engage in a certain behaviour and coming across as self-righteous.

There may also be an element of mob mentality at play with vaxxies. Due to excessive pressure from peers, some may find themselves getting vaccinated for emotional (versus rational) reasons. While the pressure to get vaccinated is arguably positive, some individuals may have legitimate concerns which they will suppress in order to conform.

That said, this is not the same as crowd behaviour which is often shrouded in anonymity and involves blindly following others. Vaxxies are personal, identifiable messages and are not anti-social.

Another risk with vaxxies is they may encourage “brand” competition. Vaxxie posters regularly include the hashtag of their vaccine: #pfizer or #astrazeneca.

Given the mixed messaging around AstraZeneca, could a proliferation of Pfizer vaxxies discourage people from seeking out AstraZeneca, at a time when we’re encouraged to take whichever option we can?

 

Despite the risks, however, it’s clear we will need a variety of tools to encourage people to get vaccinated during this crucial phase of the pandemic. Vaxxies likely have an important role to play on this front.

And as long as they don’t seek to overtly shame or alienate others, they could help engender a strong sense of solidarity as more and more people get the jab.


Read more: ‘Virtue signalling’, a slur meant to imply moral grandstanding that might not be all bad The Conversation


Louise Grimmer, Senior Lecturer in Marketing, University of Tasmania; Gary Mortimer, Professor of Marketing and Consumer Behaviour, Queensland University of Technology, and Martin Grimmer, Professor of Marketing, University of Tasmania

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We’ve heard of R numbers and moving averages. But what are k numbers? And how do they explain COVID superspreading?


Forest Simon/Unsplash

Adrian Esterman, University of South AustraliaFirst thing in the morning, or come 11 o’clock, countless Australians anxiously wait for the daily COVID-19 case numbers, trying to understand whether their outbreak is under control, and how much longer they will be in lockdown.

As well as daily case numbers, people want to know what proportion of cases were infectious in the community, and whether there were any unlinked or “mystery” cases.

People have also been following the daily Reff, or effective reproduction number, hoping it will get below 1, showing public health measures are working to halt the spread.

However, to have a good understanding of the dynamics of an outbreak, it is also necessary to understand k, which shows how much variability there is in daily case numbers.

COVID-19 superspreaders

Many superspreading events have occurred in the current pandemic. An infectious volunteer dressed as Santa Claus, for example, visited a care home in Antwerp in December 2020, and infected 40 staff members and more than 100 residents.

Even more drastic is a South Korean woman who caused a superspreading event resulting in more than 5,000 cases in the South Korean city of Daegu.




Read more:
How to prevent COVID-19 ‘superspreader’ events indoors this winter


Meanwhile in Australia, we have seen many examples of cases being detected, but not infecting a single other person.

So, how can this disparity be explained?

Remind me, what’s the Reff?

The effective reproduction number Reff, also called Re or R(t), tells us, on average, how many people an infected person will pass it on to. Unlike the basic reproduction number, R0, Reff takes into account that some people will be vaccinated or immune, and social distancing is in place.

So, if a virus has a Reff of 2, each infected person (primary case) will on average infect two others (secondary cases).

However, this average hides a huge amount of variability. Most infected people simply infect no one, whereas others (the superspreaders) infect many people.




Read more:
A few superspreaders transmit the majority of coronavirus cases


We’re unsure why this is the case. It could be some people are naturally social animals, or fail to maintain social distancing, mask-wearing, or hygiene.

Alternatively, it could simply be that some people have a much higher viral load than others or tend to emit virus particles as aerosol clouds more than others.

Daily case numbers can vary substantially

During periods of outbreaks, health authorities report daily case numbers. Here they are for Victoria when the fifth lockdown began:

Average daily count

The average (mean) daily count over these ten days is 10.7 cases per day (you can calculate it yourself by adding up all the cases and dividing by ten).

However, there is a lot of variability, with numbers going up and down like a yo-yo from zero to twenty. Because of this variability, we often use moving averages to try and smooth things out.

7 day moving average

For a seven-day moving average, we add up the cases from July 12 to the 18 and divide by 7, to get 8.4. Then we do the same for July 13 to the 19 to get 10.3.

This way, we end up with a much smoother series of numbers without all the up and down jags, that allows us to see trends much more easily. Importantly, I also use the moving average to calculate the Reff.

Variance

We measure the amount of variability in the daily case numbers by a statistic called the variance. This measures how far apart the daily counts are from their average value of 10.7. For most count data (for example, the number of days each month you exercise), the average and variance are the same. So, if the average count is 10.7, the variance is 10.7.

However, for this epidemic, because of the superspreaders, the variance is much greater – we call this overdispersion.

So what is the k?

An estimate of how much extra variability or overdispersion there is, is measured by a statistic called k. A small k means the variability is higher than the average daily count, whereas a large k means the variability is closer to the average daily count.

So, with a high value of k (say 2), and a Reff of 2, most infected people would typically infect two others, but it could of course be higher or lower than this.


Source: The Conversation/Adam Kleczkowski (CC-BY-ND)

In the above diagram, the number of people a case infects is shown in each circle. The original maroon (primary) case infects two others (red). Each of these secondary cases infects three or four others (pink), and so the outbreak continues. Typically, most infected people, infect at least one other person.

However, with k close to 0 and a Reff of 2, most people would infect no one else, and there would be one or more superspreaders.


Source: The Conversation/Adam Kleczkowski (CC-BY-ND)

In the above diagram, the primary case (maroon) is a superspreader, infecting 16 other people. Although most of these secondary cases do not infect anyone else, one of the tertiary cases is also a superspreader, infecting 11 others.

In both diagrams the Reff was 2. So, you can see that knowing the Reff is only part of the story.

Estimates of COVID-19’s k range from 0.1 to 0.5. These are very small values, and indicate 80% of secondary infections are caused by around 10% of primary cases. This means the majority of infectious people do not infect anyone.




Read more:
Is the K number the new R number? What you need to know


Why is it useful to know the k?

When an infected person is diagnosed, contact tracers immediately try and find their close contacts. These are then tested and put into isolation. This is called forward contact tracing.

However, in the context of superspreaders, it’s equally important to find out who infected the original diagnosed case, as that person could potentially be a superspreader.

Forward contact tracing of that potential superspreader would likely lead to many more cases being detected. In fact, modelling has found looking backwards as well as forwards could prevent two or three times as many infections. This is known as backward contact tracing and is now widely used in Australia.

The k number shows us the importance of backwards as well as forwards contact tracing.The Conversation

Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Who were Australia’s best prime ministers? We asked the experts


Public Domain except Hawke, Keating and Howard (Commonwealth of Australia CC-BY-SA)

Paul Strangio, Monash UniversityWho have been Australia’s most accomplished prime ministers? Curiously, it’s a question that is seldom asked. We enthusiastically compile lists of the greatest films or sporting champions, but rarely do we apply the same energy to thinking about prime-ministerial virtuosity.

More common is the rush to condemn incumbents. For example, a recent venomous piece of commentary on Scott Morrison demanded to know: “Have we ever been led by a worse prime minister than this smirking vacuum?”

The problem with these hyperbolic attacks is that they lack context. How does Morrison’s leadership compare to his 29 predecessors? And, in any case, is it too early to properly judge his performance given his prime-ministerial project is incomplete?




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What makes a great prime minister?

Evaluating leadership performance is replete with difficulties. This is despite the fact that, in democratic systems like ours, the mark of leadership achievement can appear deceptively simple.

On first consideration, longevity of office appeals as the sine qua non of successful political leadership. After all, winning government is the chief prize for a political leader, and retaining power, which is indicative of holding onto public support, affords the primary means by which to exercise influence.

Yet further reflection suggests survival alone is not a sufficient criterion of leadership success: it must also take account of what is accomplished with power. Indeed, should the legacy of a leader’s time in office be the paramount test of performance?

But then a new problem: how are we to construct meaningful and agreed upon measurements of the scale and quality of that legacy? Surely, for instance, the benchmark has to be more than the legislative productivity of a leader’s government. Yet once we endeavour to devise qualitative measurements that factor in the impact of the changes a leader has wrought, we inevitably run into disagreements about whether those changes were for good or bad.

One way of sidestepping the difficulties of evaluating political leadership is expert rankings. That is, ranking evaluations gained from people with professional knowledge, rather than surveys based on population sampling.

These have a storied history in the United States. Presidential rankings are not only conducted regularly but their results painstakingly analysed and hotly debated.

In parliamentary democracies such as Australia, leadership rankings have taken longer to catch on. But they have gained a foothold in recent decades. Most of them have been ad hoc surveys of a small number of public intellectuals and commentators initiated by broadsheet newspapers.

In 2010 and again in 2020, however, large-scale expert rankings surveys have been run out of Monash University. Sixty-six political scientists and political historians participated in last year’s survey. They were asked to rate the performance of all prime ministers, barring the incumbent (Morrison was not included as Julia Gillard was not included in the 2010 survey), and the three caretakers, Earle Page, Frank Forde and John McEwen, who briefly warmed the prime-ministerial seat following the death of an incumbent.



John Curtin, war-time PM, rated our greatest leader

The results of the 2010 and 2020 Monash surveys suggest there is a reasonable consensus about who have been our best prime ministers.

The top-rated national leader is Australia’s second world war prime minister and co-architect of its post-war reconstruction regime, John Curtin. Next comes Bob Hawke, whose governments modernised and internationalised Australia’s economy in the 1980s through market-based reforms cushioned by an overlay of social democratic values.

Third-ranked is Alfred Deakin, the Liberal Protectionist prime minister and the chief architect of the nation-building edifice laid down in the first Commonwealth decade. It included, among other things, tariff protection, an industrial arbitration system and the beginnings of a welfare state through provision of old age pensions.

John Curtin (second from left), who led Australia through the second world war and co-designed its post-war reconstruction, has been ranked our best prime minister.
AAP/AP

Ben Chifley, Curtin’s collaborator in the design of the post-war reconstruction Keynesian welfare state, is also in the top echelon. He is followed by Robert Menzies, the father of the modern Liberal Party and Australia’s longest-serving prime minister.

Others who make the top tier or are close to it are: Gough Whitlam, the reforming titan whose government dramatically modernised Australia in the early 1970s; Andrew Fisher, Australia’s first majority prime minister whose legacies included the establishment of the Commonwealth Bank and maternity allowances; and, in a delicious irony, the two great rivals, Paul Keating and John Howard. Keating is the big improver from the 2010 Monash ratings.

Longevity in office isn’t everything

The 2020 rankings also asked participants to rate prime ministers in nine performance areas. These were: effectively managing cabinet, maintaining support of party/coalition, demonstrating personal integrity, leaving a significant policy legacy, relationship with the electorate, communication effectiveness, nurturing national unity, defending and promoting Australia’s interests abroad, and being able to manage turbulent times.



Looking for correlations between performance in these areas and overall ratings it was evident that there was a close nexus between a high ranking and being scored strongly for policy legacy. The upper echelon prime ministers – Curtin, Hawke, Deakin, Chifley, Menzies, Keating, Whitlam, Fisher and Howard – were all in the top grouping for policy legacy.

Julia Gillard rounded out the policy legacy top ten, which seemed to go a long way to explaining her healthy rating in the upper middle tier of the former prime ministers.

Julia Gillard was ranked highly for policy significance during her time as prime minister.
Lukas Coch/AAP

It appears that in the minds of the participants the relationship with the electorate, while also important, ranks behind policy achievement in significance. Whitlam, Fisher and Keating were all outside the top ten for winning favour with the electorate, but are still highly ranked.

This is further reflected in the fact that, while Australia’s three most durable prime ministers – Menzies, Howard and Hawke – all make or are near the top tier, the next four longest-serving prime ministers and multiple election winners, Malcolm Fraser, Billy Hughes, Joseph Lyons and Stanley Bruce, do not.

In short, though longevity is important, what a prime minister does with office counts more to the experts. Strikingly, all of the top-ranked leaders were either the initiators or consolidators of major policy settlements.

A high score for nurturing national unity also strongly correlates with a favourable overall rating. Howard’s below-average result on that measure seems to disqualify him from pushing further up among the top-ranked prime ministers.

Conversely, the connection was weakest between a high ranking and the integrity performance benchmark. This does not mean the experts paid no heed to integrity. Rather, they had a generally favourable view of the collective integrity of our prime ministers, regarding them as a fundamentally upright bunch.

And who were the duds?

What about the prime ministerial dunces? There is not only a consensus about who have been our best prime ministers but also our worst.

William ‘Billy’ McMahon was ranked our worst prime minister, but Tony Abbott is hot on his heels.
Museum of Australian Democracy

William McMahon, who was the nation’s leader in the dying days of the Liberal Party’s post-WWII ascendancy and was defeated by Whitlam at the December 1972 election, wins that dubious honour.

Yet the 2020 rankings suggest he now has a rival for that ignominious status: Tony Abbott. Indeed, despite squeaking ahead of McMahon on the overall performance question, Abbott exceeded him for the number of failure ratings: 44 to 41. Against the nine benchmarks, Abbott is ranked last for policy legacy and nurturing national unity. McMahon is bottom for six of the nine areas, among them integrity (part of his entrenched reputation is that of an inveterate schemer and leaker).




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Notably, three of the four most recent prime ministers – Kevin Rudd, Malcolm Turnbull and Abbott – are situated towards or in the rear of the ratings pack. Together, they occupy the three bottom rungs for management of party/coalition. This suggests respondents hold them, rather than their colleagues, chiefly responsible for their depositions by party-room revolts.

The clear exception among the post-Howard prime ministers is Gillard. Though still only middle-ranked overall, she is by far the highest-rated leader among this ill-starred group.

Where will Morrison end up in the rankings? The short answer is that it is too early to tell since his is an unfinished story. The COVID-19 pandemic has ensured his incumbency will be a significant one, either for good or bad.

Yet the lack of much in the way of tangible policy achievements to this point does not bode well for his rating.The Conversation

Paul Strangio, Professor of Politics, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

National Cabinet’s plan out of COVID aims too low on vaccinations and leaves crucial questions unanswered


Danielle Wood, Grattan Institute; Stephen Duckett, Grattan Institute, and Tom Crowley, Grattan InstituteAt Friday’s National Cabinet meeting, our nation’s leaders put some meat on the bones of their 4-stage plan to reopen Australia.

The plan includes target vaccination thresholds and some details on restrictions that might be lifted at each stage. So far so good.




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But the plan raises two major concerns.

First, the reopening threshold is low. We won’t know until we see the modelling, but it looks like the National Cabinet is taking a gamble that the outcomes of re-opening will be at the more rosy end of plausible scenarios.

Second, many important details are still missing, including the timing of each stage and, crucially, the steps the government is taking to get more jabs in arms.

The vaccine coverage thresholds for re-opening look low

The key stage of the plan is stage C. In stage C, the government commits to no more mass lockdowns, and vaccinated Australians can leave the country and return without quarantine.


ScreenShot from Scott Morrison’s LinkedIn page

The government says we need 80% of Australians over 16 vaccinated before we get to stage C.

The over-16 qualifier matters a lot. The virus doesn’t care who is eligible. Children can still transmit the virus and so transmissibility depends on vaccine rates across the population.

Getting to 80% of Australians over 16 I equates to just under 65% of all Australians – far lower than the 80% threshold Grattan Institute recommends for starting to re-open international borders.




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The Doherty Institute modelling that informed the plan has not been released. The institute likely presented a range of scenarios. The Australian public have a right to understand the health outcomes in each and the way in which National Cabinet weighed the uncertainty in the modelling.

Committing to a vaccine coverage threshold that is too low risks a rapid surge in COVID cases that could overwhelm our hospitals and impose a high death toll. State governments would almost certainly impose lockdowns to contain this type of spread, pushing “real” reopening further back.

Coverage too low to loosen restrictions for the vaccinated

The steps discussed in stage B also contribute to a greater risk of a disorderly re-opening. Stage B envisages loosening some quarantine requirements and public health restrictions for vaccinated residents.

The main concern is that stage B kicks in at 70% of the eligible population (56% of the total population).

Under almost any scenario, the reproduction number for the Delta strain of the virus is still well above 1 at this point. That means each infected person on average infects more than one other person.

Relaxing international arrival and quarantine restrictions for vaccinated adults – who can still transmit the virus (albeit less so than the unvaccinated) – means more Delta will get in. And allowing exemptions from public health measures for vaccinated residents means the measures to contain the spread of the virus will be less effective.




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With only 56% of the population vaccinated, any uncontrolled spread will translate into high rates of serious illness and hospitalisation.

Our governments will be walking a very fine line indeed.

No details on ramping up the vaccine program

The other major concern is the lack of detail about how the National Cabinet plans to ramp up the vaccine program, and timeframes for doing so.

The most concerning line of the prime minister’s Friday evening press conference was “it is all up to us” – suggesting success is largely out of the government’s hands.

Getting enough jabs into arms as quickly as humanly possible is a job for government. We need a step change in the planning and professionalism of the rollout if we are going to have any hope of making these targets in a reasonable timeframe.

Grattan’s Race to 80 report, released last week, set out the necessary steps.

On logistics, it means delivering vaccines not just through GPs but via state-run mass vaccination hubs, pharmacists, schools, workplaces, and through pop-up clinics at community halls, public transport stations, and sporting events.

On messaging, it means high-quality national campaigns but also more targeted messaging for hesitant and harder-to-reach groups, including women, young people, and those from culturally and linguistically diverse communities.




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It looks like National Cabinet has not yet considered the crucial question of whether we need vaccine passports in high-risk settings such as restaurants and major events, to encourage people to get the vaccine and to reduce the risks of superspreading events.

And there is no plan to vaccinate children, even though Australia’s regulator, the Therapeutic Goods Administration (TGA), has already approved Pfizer for 12-to-16 year olds.

More to do

Australia can’t afford much more delay. The key planks of the logistics, messaging, and incentive campaigns need to be in place very soon if we are going to substantially increase the pace of the rollout as more Pfizer doses arrive in coming months.

At the same time, governments should release the Doherty modelling to help Australians understand the expected health outcomes under each of the four stages.

Vaccinations are the route back to normal life. This means all Australians have a stake in making sure our governments get this plan right.




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The Conversation


Danielle Wood, Chief executive officer, Grattan Institute; Stephen Duckett, Director, Health Program, Grattan Institute, and Tom Crowley, Associate, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

To ensure supply of the top 3 drugs used to treat COVID-19, it’s time to boost domestic medicine manufacturing


Nial Wheate, University of Sydney; Elise Schubert, University of Sydney, and Ingrid Gelissen, University of SydneyWe now know enough about how COVID works for health authorities to have issued clear guidance on which drugs doctors should use on hospitalised patients. The recommended drugs are dexamethasone, remdesivir, and tocilizumab.

Remdesivir, also known as Veklury, is not manufactured in Australia and the Therapeutic Goods Administration (TGA) has recently issued an alert warning of a shortage of tocilizumab in Australia. And the large dexamethasone manufacturers are based overseas. The website Pharmaoffer, which shows suppliers of active pharmaceutical ingredients, lists the countries that produce the active ingredient in dexamethasone; Australia is not one of them.

More broadly, Australia lacks medicines manufacturing capability and this puts us at significant risk should supplies from overseas continue to be interrupted.

One report released last year described the Australian market for pharmaceuticals as “possibly one of the most vulnerable in the OECD”.

It’s time for Australia to re-invest in domestic medicine manufacturing.

Drugs used to treat COVID-19

Many people diagnosed with COVID-19 experience only mild, or no symptoms at all, and can be managed and monitored at home. Rest is the main treatment, and medicines such as paracetamol and/or ibuprofen can provide symptomatic relief of any mild fevers.

People with moderate to severe COVID-19 are treated in hospital. The medicines doctors will prescribe in hospital depend on a patient’s clinical circumstances, such as whether or not they are receiving oxygen therapy.

The pharmaceutical treatment options include:

  • dexamethasone, a corticosteriod
  • remdesivir, an antiviral and
  • tocilizumab, a monoclonal antibody and immunosuppressive agent (monoclonal antibodies are lab-made proteins that mimic the immune system’s virus-fighting abilities).

Dexamethasone is already used for a wide range of conditions, such as certain forms of cancer and arthritis, and various other disorders. Now, it is used in treatment of COVID-19 to suppress inflammation and immune responses.

Remdesivir works by stopping the replication of viral RNA.

And tocilizumab is sometimes used when COVID-19 patients have signs of systemic inflammation.

Dexamethasone is already used for a wide range of conditions.
Nati Harnik/AP

Where are they made?

Australia is heavily reliant on supply agreements for medicines that come from overseas (and a manufacturing network might include a lot of countries). It’s been reported some of the large dexamethasone manufacturers are in Brazil and India.

To meet growing demand for remdesivir, its company (Gilead) has approved new deals for manufacturing in Egypt, India, and Pakistan. But while the remdesivir manufacturing network now includes more than 40 companies in North America, Europe, and Asia, the medicine is not manufactured in Australia.

Tocilizumab was developed in Japan and is now also licensed for manufacturing by the California-based company Genentech.

Need for Australian manufacturing base

There is an urgent need for Australia to increase local manufacturing of many types of medicines, not just COVID treatments, to secure current and future needs.

In general, Australia does have some medicine manufacturing sites in Australia but several have either closed or are slated for closure.

The Australian government has acknowledged the importance of boosting local production of medicines but it’s unclear what progress has been made.

In March this year, an interim report by the Productivity Commission on vulnerable supply chains again indicated medicines as an area of concern, noting that

the pharmaceutical industry is highly regulated, making entering the market or modifying existing facilities to respond to a crisis a slow and costly process.

The final report from this committee is currently with the government.

Manufacturing of medicines in Australia is regulated by the TGA. According to its website, it can take up to 12 months for an Australian manufacturer to get approval to bring a new manufacturing site online. This means it would take us a long time to act if a supply shortage pops up.

Significant backing from the federal government for local medicine manufacturing would reduce the risk of key medicine shortages in Australia, while also creating many highly skilled jobs.The Conversation

Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of Sydney; Elise Schubert, Pharmacist and PhD Candidate, University of Sydney, and Ingrid Gelissen, Associate Professor in Pharmaceutical Sciences, School of Pharmacy, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.